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Suzanne was hooked on drugs and alcohol, perfectionism, and managing
her body image – which became an eating disorder. Until recently,
co-existing conditions like Suzanne’s were called dual diagnosis
and co-morbidity. Dual diagnosis denoted either the
presence of two or more addictions or the presence of chemical
dependence along with a mental health problem such as major depression,
bi-polar disorder, anxiety disorder, etc. Obviously, one set of
symptoms can complicate the diagnosis and treatment of the second set
of symptoms.
Suzanne’s dilemma is an excellent example of the way various unhealthy
dependencies interact. As a result of alcohol and marijuana use, she
gained weight, which compelled her to diet strenuously because she
couldn’t allow herself to be less than perfect. Next came the abuse
of diet pills, followed by bulimiarexic behavior (periods of
self-starvation alternating with periods of bingeing and purging). The
fear and guilt accompanying these actions made Suzanne so miserable that
she drank to escape her negative feelings, which increased her caloric
intake and thus her weight, for which she tried to compensate by starving
herself or by over-eating and then purging.
In the realm of multiple interacting dependency disorders, there are
several other common combinations: (1) alcoholism plus workaholism, (2)
alcoholism and rageaholism, which often acts itself out as spouse or
child abuse, (3) workaholism alternating with sexaholism, (4) relationship
addiction along with chemical dependence, and (5) religion addiction
plus sexaholism. I have yet to meet an addict who is subject to only
one addiction. Multiple interacting dependency disorders are probably
the norm in this society.
In fact, it is not uncommon for an addict to struggle with three or more
major compulsions. I’ve had several clients recently who were suffering
from a combination of sexaholism, religion addiction, and workaholism.
Another typical combination is relationship addiction and compulsive
caretaking, which interface handily with addiction to misery and worry.
Each plays off the other and creates incredible internal conflict.
The conjunction of workaholism and alcoholism demonstrates how various
dependencies exacerbate one another. Some workaholics pump so much
adrenaline during the workweek that they have to drink on the weekend
in order to relax, which places them at risk for alcoholism. If they
“act out” in some way while they are drinking (sexually, for example),
they are compelled to work even harder the next week to redeem themselves
for the ways in which they acted out when they were drunk. Guilt plays
a role in perpetuating addictive behavior.
Dr. Patrick Carnes, internationally known expert on sexual addiction,
says that compulsive behaviors are interrelated, like gears in a machine.
If one addiction is activated, the others will be close behind. Thus, to
prevent relapse, all addictions – not just one of them – must be addressed
therapeutically. I believe it is best to treat multiple addictions
simultaneously or in close sequence, which obviously requires extended
care. The common roots of the various unhealthy dependencies (arrested
development, emotional repression, shame, lack of boundaries, etc.) must
also be addressed. A good treatment program covers all of these bases.
In his book Don’t Call It Love, Dr. Carnes offers these suggestions
for addicts suffering from multiple dependencies: (1) work on the most
threatening addiction first, then work on the next most threatening; (2)
get a sponsor and a solid home group (twelve-step fellowship) for each
addiction; (3) learn how the addictions interact and how each is
stimulated; (4) recognize that they are all connected to shame – face
shame and work it out therapeutically; (5) make yourself personally
accountable to others; and (6) remember that sobriety in one program
does not guarantee sobriety in another.
Suzanne is enjoying sobriety and high-quality relationships today because
she was willing to take these issues into account. She understands that
a multifaceted disease such as hers requires a multifaceted recovery
regimen. She knows that there are no instant cures. All she will ever
have is a daily reprieve from her illness based upon the consistent
maintenance of her spiritual program.
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